@TumorBoardTues @JenniferLitton @marijasullivan @MPishvaian @MDAndersonNews @BreastCaupdates @BRCAUmbrella @hoperugo @Dr_RShatsky 2/5 #TumorBoardTuesday
Take🏠:
✅ 🧬test 🗝️! Biomarkers 👉 best tx
✅ OlympiA: OS & IDFS⬆️w Olaparib- gBRCAm
✅ MonarchE: IDFS⬆️ w abema +ET- HR+
✅ Fertility pres & interrupting adj tx (if desired) for pregnancy
📚@JenniferLitton @marijasullivan’s thread
threadreaderapp.com/thread/1648476… @TumorBoardTues @JenniferLitton @marijasullivan @MPishvaian @MDAndersonNews @BreastCaupdates @BRCAUmbrella @hoperugo @Dr_RShatsky 3/5 #TumorBoardTuesday
Thursday Case🎀

🎥 TBT in a video
@marijasullivan summarizes adj tx based on biomarkers. How to approach pts w gBRCA1/2m & HR+? Need more data!

🔹gBRCAm👉 Olaparib x 1y
🔹 HR+👉 Abemaciclib + ET x 2y -> ET; data expected on other CDK4/6i soon (ribociclib)

@TumorBoardTues @shafiarahman_ @RischZack @MPishvaian @ColonCancerCoal @colontown @coloncancermike @GlobalCRC 2/6 #TumorBoardTuesday
Thurs Case🎀

#mCRC & #EGFR tx:
✅Anti-EGFR useful in RAS/RAF WT; debate re: timing vs anti-VEGF
✅Pt centered discussion including SEs 🗝️
✅Emerging data: EGFR re-tx, using ctDNA to guide

📚@shafiarahman_ @RischZack’s thread:
threadreaderapp.com/thread/1638330… @TumorBoardTues @shafiarahman_ @RischZack @MPishvaian @ColonCancerCoal @colontown @coloncancermike @GlobalCRC 3/6 #TumorBoardTuesday
🎥 TBT in a vid- Part 1:

@shafiarahman_ 's approach: pt eligible for EGFR-directed tx in #metastatic #CRC
🔹RAS/RAF WT- more important than side
🔹Bev or pan 1L? Trend toward pan, but is 🗝️actually that pt gets anti-EGFR in tx, 🚫necessarily 1L?

@TumorBoardTues @brian_rini @JVentoMD @MPishvaian @Uromigos @JoshLangMD @renalandurology @UroDocAsh 2/5 #TumorBoardTuesday
Thurs Case🎀

Take🏠msgs:
✅ Pembro ONLY approved adj IO in RCC
✅ 3 recent trials w IO failure: nivo/ipi, atezo & periop nivo
✅ Must balance risks vs benefits- shared decision-making 🗝️

📚@brian_rini @JVentoMD’s thread:
threadreaderapp.com/thread/1635792… @TumorBoardTues @brian_rini @JVentoMD @MPishvaian @Uromigos @JoshLangMD @renalandurology @UroDocAsh 3/5 #TumorBoardTuesday
Thurs Case🎀

🎥 TBT in a video
High risk #RCC, pembro= DFS advantage, but w cost- Grade 3 AEs= 32%. High risk #RCC defined by:
🔹Stage II w sarcomatoid features
🔹Stage III+
🔹Regional LN+/M1 disease

Quick overview of adj IO decision making:

@TumorBoardTues @DrSteveMartin @DAielloMD @MPishvaian @NarjustFlorezMD @EGFRResisters @lcrf_org @ADesaiMD @GDutcherMD 2/5 #TumorBoardTuesday
Thurs Case🎀

Take🏠msg:
✅ctDNA= both tx decision making & MRD in #NSCLC
✅Identify actionable muts in dz where a bx not possible
✅Pros (serum test) & cons ($, inability to multiplex with IHC- aka PD-L1 status)

📚The thread:
threadreaderapp.com/thread/1633271… @TumorBoardTues @DrSteveMartin @DAielloMD @MPishvaian @NarjustFlorezMD @EGFRResisters @lcrf_org @ADesaiMD @GDutcherMD 3/5 #TumorBoardTuesday
Thurs Case🎀

🎥 TBT in a video
ctDNA + tissue-based NGS= highest sensitivity (do NOT miss actionable mutations in #NSCLC).
ctDNA can be used to:
🔹Identify actionable mutations
🔹Track disease status (MRD)
🔹Adapt targeted therapies based on 2dary muts

@TumorBoardTues @drsarahsam @PTarantinoMD @stolaney1 @MPishvaian @BreastCaupdates @BCRFcure @BCAction @LivingBeyondBC @RenoHemonc 2/5 #TumorBoardTuesday
Case🎀

✅CDK4/6i +endocrine tx= 1L HR+ mBC
✅Ribo =⬆️OS; select based on shared decision
✅After prog on CDK4/6i, eval muts (ESR1, PIK3CA)➡️SERD vs PIK3CAi
✅Benefit in adj- monarchE

📚Here’s @drsarahsam @PTarantinoMD’s thread
threadreaderapp.com/thread/1630734… @TumorBoardTues @drsarahsam @PTarantinoMD @stolaney1 @MPishvaian @BreastCaupdates @BCRFcure @BCAction @LivingBeyondBC @RenoHemonc 3/5 #TumorBoardTuesday
Case🎀

🎥 TBT in a video: HR+ #mBC tx has changed significantly, esp in 2L setting.

Check out this SHORT video w algorithm to approach tx after progression on CDK4/6i:

A bigger and bigger role for 🎯 medicine to select next best therapy!

@TumorBoardTues @ShrutiPatelMD @NarjustFlorezMD @LungAssociation @DrSteveMartin @FawziAbuRous @esinghimd @RenoHemonc @HemOncFellows 2/5 #TumorBoardTuesday
Thurs Case🎀
✅Biomarker - sq cell #LC, chemoIO is the SOC
✅Pembro, cemi, ipi/nivo approved in 1L squamous cell lung cancer—must be paired with chemo if PD-L1 TPS < 50%
✅ irAEs can be very serious- early, multi-D mgmt is 🗝️

https://twitter.com/ShrutiPatelMD/status/1628199185056153604

@TumorBoardTues @ShrutiPatelMD @NarjustFlorezMD @LungAssociation @DrSteveMartin @FawziAbuRous @esinghimd @RenoHemonc @HemOncFellows 3/5 #TumorBoardTuesday
Thurs Case🎀

📽️TBT video wrap up:

IO has fundamentally changed 🫁 cancer tx.
Choosing the right strategy in squamous cell lung ca largely based on PD-L1 status; we’re hoping for more, & better, biomarkers in the future.

@TumorBoardTues @arkhaki @glovedoc @PGrivasMDPhD @rafee_talukder @MPishvaian @Uromigos 2/5 #TumorBoardTuesday
Case🎀

Take🏠
✅For plat ineligible, pembro=1L option
✅4 cycles of plat tx ➡️ IO maint equally efficacious to 6 cycles
✅Early prog predicts⬇️2L IO benefit
✅💔Myocarditis irAE needs aggressive mgmt

📚@arkhaki @glovedoc’s thread
threadreaderapp.com/thread/1625661… @TumorBoardTues @arkhaki @glovedoc @PGrivasMDPhD @rafee_talukder @MPishvaian @Uromigos 2.5/5 #TumorBoardTuesday

Bonus: @PGrivasMDPhD & @rafee_talukder recently discussed platinum eligibility & tx options- take a look here:
threadreaderapp.com/thread/1612977…

@TumorBoardTues @drteplinsky @stolaney1 @hoperugo @dradityabardia @BreastCaupdates @BCRFcure @MBCNbuzz 2/5 #TumorBoardTuesday
Take🏠msgs:
✅HER2 low= 1+ to 2+ IHC, -FISH
✅T-Dxd approved in 1L HER2 low
✅Watch tox, esp ILD (need reg CT thorax)!
✅TROP-2 ADCs an option (Sacituzumab govitecan); choose based on pt profile, agent tox

📚@drteplinsky’s thread:
threadreaderapp.com/thread/1623124… @TumorBoardTues @drteplinsky @stolaney1 @hoperugo @dradityabardia @BreastCaupdates @BCRFcure @MBCNbuzz 3/5 #TumorBoardTuesday
🎥 TBT in a video
New 1L T-DXd option for patients w #mBC (HER2 low, ER/PR-).

T-DXd is an antibody drug conjugate (ADC), tethering deruxtecan payload to HER2 ab. Improvements over chemo in mOS and PFS, but watch carefully for ILD and all toxicities!

@TumorBoardTues @drteplinsky @MPishvaian @PTarantinoMD @DFCI_BreastOnc @KariWisinski_MD @JaniceTNBCmets @her2bc 2/4 #TumorBoardTuesday
Thurs Case🎀

Take🏠messages:
#HER2+ #BreastCancer
✅Localized, early ➡️neoadj tx w chemo + anti-HER2
✅⬆️DFS w T-DM1 for residual disease
✅Future role for T-DXd?

📚We captured @drteplinsky’s discussion in this moment: twitter.com/i/events/15831… @TumorBoardTues @drteplinsky @MPishvaian @PTarantinoMD @DFCI_BreastOnc @KariWisinski_MD @JaniceTNBCmets @her2bc 3/4 #TumorBoardTuesday
Thursday Case🎀

📷 TBT in an image: Take a 👀at a (simplified) guide to treatment of early stage HER2+, localized #BreastCancer!

We review KATHERINE and use of ADCs to improve OS with residual disease. Is there an evolving role for T-DXd?

@TumorBoardTues @n8pennell @MPishvaian @ShrutiPatelMD @NarjustFlorezMD @OncBrothers @jillfeldman4 @Joshua_Reuss @JineshGheeya @ClevelandClinic 2/4 #TumorBoardTuesday
Thurs Case🎀
Take🏠
#EGFRm #NSCLC:
✅Wait on NGS- IO +TKI=⬆️tox
✅Osimertinib= ex19, 21m
✅New ADCs, small molecules= future options
✅ Re-bx on prog EGFRm- rule out small cell transformation

📚We captured @n8pennell’s discussion:
twitter.com/i/events/15780… @TumorBoardTues @n8pennell @MPishvaian @ShrutiPatelMD @NarjustFlorezMD @OncBrothers @jillfeldman4 @Joshua_Reuss @JineshGheeya @ClevelandClinic 3/4 #TumorBoardTuesday
Thursday Case🎀

📷 #TBT in an image: we’ve summarized some key pts re: EGFRm #NSCLC & emerging data- hope to see more ADCs as 3L options for pts with EGFRm disease in the future!

@TumorBoardTues @maryam_lustberg @JasmineSukumar @MPishvaian @JaniceTNBCmets @drteplinsky @ParamMD 2/ #TumorBoardTuesday
Thurs Case🎀

Take🏠messages :
PIK3CA mutations in ER+ #mBC
✅PIK3CA mut are common- 20-30% of all #BreastCancer & 40%+ of ER+ #mBC
✅PIK3CAm are present in founder clones!

📚We captured as much of the discussion as we could:
Pt 1 twitter.com/i/events/15719… @TumorBoardTues @maryam_lustberg @JasmineSukumar @MPishvaian @JaniceTNBCmets @drteplinsky @ParamMD 3/5 #TumorBoardTuesday
Thursday Case🎀

Take🏠messages (Part 2):
✅Alpelisib is a PIK3CA inhib= 5.3 mo ⬆️in PFS
✅Side effect mgmt is key- esp. 💩diarrhea,
🍦hyperglycemia
✅Personalized medicine needs personalized side effect mgmt

Part 2 of our convo twitter.com/i/events/15729…

@TumorBoardTues @NarjustFlorezMD @ShrutiPatelMD @MPishvaian @LatinxOncology @dawood_findakly @LungAssociation 2/3 #TumorBoardTuesday
Thurs Case🎀

Take🏠messages:

✅3 agents (pembro, atezo, cempilimab) 👍🏽PD-L1 TPS >50% in 1L
– No head to head ICI comparisons
✅OS BETTER w IO alone vs chemo
✅💰tox huge problem!
📚We captured the convo in this moment:
twitter.com/i/events/15675… @TumorBoardTues @NarjustFlorezMD @ShrutiPatelMD @MPishvaian @LatinxOncology @dawood_findakly @LungAssociation 2.5/3 #TumorBoardTuesday
Thurs Case🎀

Key factors to choose ICI (in absence of head to head trials):
- Pt experiences/preferences
- Dosing schedule
- $$$ toxicity

The good news: across 3 separate agents (pembrolizumab, atezolizumab, cemiplimab) OS is BETTER w IO alone vs chemo

@TumorBoardTues @HosseinBorghaei @ShrutiPatelMD @KevinCalsina @DrRoyHerbstYale @NarjustFlorezMD @MPishvaian @EricaMarieRomn1 @Latinamd @KinhHoang_MD 1/3 #TumorBoardTuesday
Case🎀

Take🏠messages:
In unresectable stage III #NSCLC:
✅ChemoXRT -> IO is SOC
✅STK11 = ⬇️response to IO, but IO still👍🏼after chemoXRT
✅New IO combos- COAST trial ongoing

📚We captured @HosseinBorghaei’s discussion:
twitter.com/i/events/15648… @TumorBoardTues @HosseinBorghaei @ShrutiPatelMD @KevinCalsina @DrRoyHerbstYale @NarjustFlorezMD @MPishvaian @EricaMarieRomn1 @Latinamd @KinhHoang_MD 2/3 #TumorBoardTuesday
Case🎀

📷 TBT in an image:

We summed it up in a graphic- check out management of unresectable stage III #NSCLC, with updated data from PACIFIC, + exciting data from ongoing COAST trial (evaluating anti-CD73 w ICI; anti-NKG2A w ICI).

@TumorBoardTues @hoperugo @laura_huppert @ErikaHamilton9 @MPishvaian @PTarantinoMD @stolaney1 @drteplinsky @JaniceTNBCmets @UCSFCancer 2/3 #TumorBoardTuesday
Thurs Case🎀

Take🏠:
✅HER2 LOW= IHC1+ OR IHC2+ w - ISH (67% HR+!)
✅T-DXd= after 1L chemo in HER2 low
✅Careful monitoring for ILD!

📚We captured @hoperugo & @LauraHuppert’s discussion in below:

twitter.com/i/events/15588…

twitter.com/i/events/15601… @TumorBoardTues @hoperugo @laura_huppert @ErikaHamilton9 @MPishvaian @PTarantinoMD @stolaney1 @drteplinsky @JaniceTNBCmets @UCSFCancer @LauraHuppert 2.75/3 #TumorBoardTuesday

Check out this graphic outlining the key role for ADCs in the tx of HER2 low #MBC after prior 1L chemo and endocrine therapy.

Hoping for even more changes in the near future w
DB-06!

@TumorBoardTues @brian_rini @DrChoueiri @RenoHemonc @tompowles1 @CParkMD @RCCadvocate @EricaMarieRomn1 @jacobadashek 2/5 #TumorBoardTuesday
Thursday Case🎀

Take🏠:

✅High risk feat= consider adj tx
✅Sunitinib= FDA ☑️; can be hard to tolerate
✅Pembro= FDA ☑️ w DFS benefit
✅irAE mgmt - gr3+= steroids

📚We captured @brian_rini’s discussion in this moment: twitter.com/i/events/15552… @TumorBoardTues @brian_rini @DrChoueiri @RenoHemonc @tompowles1 @CParkMD @RCCadvocate @EricaMarieRomn1 @jacobadashek 3/5 #TumorBoardTuesday
Thursday Case🎀

📷 TBT in an image: 👀out a clinical algorithm 📊for adj therapy in #RCC.

Some pearls re: irAE mgmt & addtl info to help choose a patient appropriate adjuvant regimen!

@TumorBoardTues @dradityabardia @ArielleMedford @Latinamd @EricaMarieRomn1 @HillStirSci @ErikaHamilton9 @stolaney1 @PTarantinoMD 2/5 #TumorBoardTuesday
Thurs Case🎀

Take🏠messages

✅BRCAm= 10-20% of TNBC!
✅PD-L1 CPS>10= PFS & OS benefit w/ IO in mTNBC
✅PARPi= PFS benefit
✅Biomarkers, side effects, pt pref key

📚We captured much of @dradityabardia @ariellemedford’s discussion: twitter.com/i/events/15548… @TumorBoardTues @dradityabardia @ArielleMedford @Latinamd @EricaMarieRomn1 @HillStirSci @ErikaHamilton9 @stolaney1 @PTarantinoMD 3/5 #TumorBoardTuesday
Thursday Case🎀

How do you choose IO vs PARPi in #TNBC w #BRCA mutation? Check out the summary and algorithm below!
Important to know there are more 2L options as well, including sacituzumab-gov & other ADCs. New trials evaluating IO+ PARPi–stay tuned!

@TumorBoardTues @PTarantinoMD @CaterinaSpo @ADesaiMD @silke4senate @DrLauraEsserman @BRCAUmbrella @hoperugo @SusanGKomen @ErikaHamilton9 @stolaney1 1/8 #TumorBoardTuesday

🔬🧬Discussion on 1L treatment for BRCA+ #MBC led by @PTarantinoMD @CaterinaSpo #BreastCancer

➡️Here’s the week's Thursday Case 🎀

👉Don’t forget your🆓 #CME credit by answering 1 quick❓
CME🔗: integrityce.com/tbt
CME eval🔗: integrityce.com/tbteval @TumorBoardTues @PTarantinoMD @CaterinaSpo @ADesaiMD @silke4senate @DrLauraEsserman @BRCAUmbrella @hoperugo @SusanGKomen @ErikaHamilton9 @stolaney1 2/8 #TumorBoardTuesday
Thursday Case🎀

Take🏠messages for germline #BRCAm & 2L tx in #BreastCancer
✅BRCAm fairly common - 10-20% of #TNBC
✅PARPi approved in met, BRCAm dz
✅Fast responses, with ORR > chemo

📚Much of @PTarantinoMD @CaterinaSpo’s chat👇🏽
twitter.com/i/events/15487…

@TumorBoardTues @CharuAggarwalMD @ADesaiMD @Latinamd @PTarantinoMD @LealTiciana @NarjustFlorezMD 1/8 #TumorBoardTuesday
🔬🧬@CharuAggrawalMD @ADesaiMD taught us about EGFR mutations in #LungCancer–specifically, new 2L strategies for EGFRexon20m.

➡️Here's this week's Thursday Case🎀
Pick up your 🆓#CME
ALL CME 🔗: integrityce.com/tbt
CME eval🔗: integrityce.com/tbteval @TumorBoardTues @CharuAggarwalMD @ADesaiMD @Latinamd @PTarantinoMD @LealTiciana @NarjustFlorezMD 2/8 #TumorBoardTuesday
Thurs Case🎀

Take🏠messages:
We discussed #EGFR mutations in #LungCancer
✅Not all EGFR mutations are the same!
✅Osimertinib=tx for most activating EGFR mutations
✅…but exon20insmut more resistant to TKIs
✅Amivantamab, mobocertinib= 2L strategies

@TumorBoardTues @Dr_RShatsky @PTarantinoMD @ErikaHamilton9 @UCSDCancer @KariWisinski_MD @marina_sharifi @JPoteralaMD @LaurenBzak @benjiwal @drteplinsky @MarkRobsonMD 2/11 #TumorBoardTuesday
Thurs Case🎀
Take🏠:
#TNBC &neoadjuvant tx
✅KEYNOTE-522= new standard of care
– Pembro+chemo in neoadj= BEST pCR so far
– Caveat: only for T2+ TNBC
✅Adding pembro may have ⬆️benefit in RCB II
📚We captured much of chat:
p1: twitter.com/i/events/15423… @TumorBoardTues @Dr_RShatsky @PTarantinoMD @ErikaHamilton9 @UCSDCancer @KariWisinski_MD @marina_sharifi @JPoteralaMD @LaurenBzak @benjiwal @drteplinsky @MarkRobsonMD 3/11 #TumorBoardTuesday
Thurs Case🎀
Take🏠msgs (cont’d):
✅IO NOT shown to add benefit in metastatic dz
– Atezolizumab approval in mTNBC withdrawn
✅Standard of care – multi-d team
✅No current evidence to hold IO pre-op
P2: twitter.com/i/events/15425…

1/8 IT’S #TumorBoardTuesday CASE WRAP UP TIME!

🫁@NarjustFlorezMD @ShrutiPatelMD taught us about EGFR mutated #NSCLC & adjuvant therapy–rapidly changing field. Summary below!

👉Don’t forget to grab🆓#CME (AMA/MOC) w 2 quick❓ CME eval & rationale🔗: integrityce.com/tbteval 2/8 #TumorBoardTuesday
Thurs Case🎀

Take🏠-pt 1
We discussed #NSCLC & EGFRm
✅EGFR mutations:
🔹Female>Male;
🔹Never smoker >> smoker
✅NEED‼️NGS data‼️BEFORE systemic tx. Order panel of common EGFR muts if limited time.

We captured much of chat:
P1: twitter.com/i/events/15369…

@TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation 1/13 #TumorBoardTuesday #LCSM
➡️Here’s this week's Thursday Case🎀!

🧬@Latinamd @GDutcherMD took us through METex14 skipping in older pts with 🫁#NSCLC.

👉Get 🆓#CME credit with quick❓

CME eval 🔗: integrityce.com/tbteval

@SylvesterCancer @TumorBoardTues @MPishvaian @SushmaJonna @Latinamd @GDutcherMD @Empoweringpts9 @ADesaiMD @JackWestMD @DrSteveMartin @esinghimd @GO2Foundation @SylvesterCancer 2/13 #TumorBoardTuesday
Thurs Case🎀

Take🏠points:

#LungCancer= molecular disease

✅IDEAL=wait for NGS before tx
✅Send tissue NGS & ct🧬
✅MET mut= RTK driver- rare!
🔷MET exon 14 skipping best detected w RNAseq
🔷Capmatinib/tepotinib= FDA👍🏽
✅METi side effects: 🤨EDEMA